794 resultados para GYNECOLOGICAL EXAMINATION
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Examination report on the City of State Center, Iowa for the period July 1, 2012 through June 30, 2013
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Examination report on the City of Mechanicsville, Iowa for the period July 1, 2012 through June 30, 2013
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Examination report on the City of Roland, Iowa for the period July 1, 2012 through June 30, 2013
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Examination report on the City of Newhall, Iowa for the period July 1, 2012 through June 30, 2013
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Case Report: A 19 year old female, originally from Cameroon, residentin Switzerland for 10 years, consults for chronic fatigue, constipationand menorrhagia. Clinical examination reveals pain in the iliac fossa,laboratory tests show an iron deficiency anaemia with a hemoglobinof 74 g/l (N: 117-157) and a ferritin less than 3 μg/l (N: 30-300).Gynecological aetiology is strongly suspected.Findings: The dietary history reveals a high intake of African chalkcalled "Mabel" in Lingala, for which she has a craving with criteria forsubstance dependence according to the Diagnostic and StatisticalManual IV. Eating non-food products is called "PICA" and the eatingof earth "geophagia". It is often assumed by the patient that geophagiaoffers nutritional virtues of the earth, and that the land would act asantitoxic, anti-emetic, immune-stimulant, strengthen the intestinalbarrier and be rich in calcium, iron and many nutrients. But insteadgeophagia causes anemia, iron chelation, heavy metal poisoningand significant constipation or obstruction.Management: The patient, following our advice, stopped ingestingchalk. Parenteral iron substitution of ferric carboxymaltose 1000 mgstopped the craving, and resolved her subjective state of fatigue andher haemoglobin normalized to 140 g/l. The menorrhagia resolved withhormone replacement and the constipation subsequently disappeared.Discussion: Our patient was suffering from iron deficiency resulting ina craving for non-food products in this case the earth. We advisepractitioners to systematically ask the question in patients of Africanand South American origin by using synonyms for the word "Mabel"(African chalk, kaolin, Kalaba, calabash chalk, calabash Stone, Kaolin,hurdle, or clay Nzu). A simple question can sometimes avoid costlyinvestigations. The ferrous replacement intravenously can probably stopthe practice of geophagy faster. Finally, we must remember that thispractice is underestimated and rarely expressed by patients as it isoften felt to be a shameful practice.
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Examination report on the City of Gilmore City, Iowa for the period July 1, 2012 through June 30, 2013
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Examination report on the City of Swea City, Iowa for the period July 1, 2012 through June 30, 2013
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Examination report on the City of Lansing, Iowa for the period July 1, 2012 through June 30, 2013
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Examination report on the City of Atkins, Iowa for the period July 1, 2012 through June 30, 2013
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Examination report on the City of Remsen, Iowa and the Remsen Municipal Utilities for the period July 1, 2012 through June 30, 2013
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Examination report on the City of Manly, Iowa for the period July 1, 2012 through June 30, 2013
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Examination report on the City of Hamburg, Iowa for the period July 1, 2012 through June 30, 2013
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Examination report on the City of Villisca, Iowa for the period July 1, 2012 through June 30, 2013
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Examination report on the Villisca Municipal Power Plant in Villisca, Iowa for the period January 1, 2013 through December 31, 2013
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Examination report on the City of Ocheyedan, Iowa for the period July 1, 2012 through June 30, 2013
